OUTREACH LABORATORY

CLIENT SUPPLY ORDER FORM

NOTE: Fax order form to 584-3905

Office Location: ______Order Date: ______

Contact Name: ______Contact Number: ______

Item / Lawson # / UOM / QTY / Item / Lawson # / UOM / QTY
BLOOD COLLECTION TUBES / URINE COLLECTION
Gold (SST) / 141248 / 100/ea / 4oz Sterile Specimen Cup(Orange Lid) / 473207 / 200/ea
Grey (Sodium Fluoride) / 164684 / 100/ea / Urinalysis Tube (Red/Yellow Swirl) / 339402 / 100/ea
Lavender (EDTA) / 163764 / 100/ea / Urine Chemistry Tube (Yellow) / 339395 / 100/ea
Light Blue (Sodium Citrate) / 307968 / 100/ea / Culture/Sensitivity (Grey Top) / 339386 / 100/ea
Light Green PST (Lithium Heparin) / 339484 / 100/ea / 24 hour urine jug – Acetic Acid / LCA / Each
Microtainer: Gold (SST) / 130467 / Box / 24 hour urine jug – Boric Acid / LCA / Each
Microtainer: Green / 339417 / Box / 24 hour urine jug – HCL / LCA / Each
Microtainer: Lavender / 105143 / Box / 24 hour urine jug – Plain / LCA / Each
Microtainer: Red (Plain) / 339412 / Box / Castile Soap Towelettes 105857 100/ea
Pink (Blood Bank EDTA) / 163763 / 100/ea / MICROBIOLOGY/MOLECULAR COLLECTION
Red (Plain) / 339468 / 100/ea / GC/Chlamydia Urine Tube
Royal Blue (Heavy Metals) / LCA / each / GC/Chlamydia M4RT Swab (100) / 416374 / Case
Yellow (ACD A ) / 105530 / each / Blood Culture Bottles: Aerobic (100) / 455068 / Each
BLOOD COLLECTION SUPPLY / Blood Culture Bottles: Anaerobic / 455069 / Each
21 gauge Safety Needle / 388619 / 100/ea / Viral Transport Media (UTM) / LCA / Each
21 gauge Butterfly / 362817 / 100/ea / Anaerobic Transport (Port-A-Cul) / LCA / Each
Needle Holder / 214263 / 250/ea / Culture Swab Red Top / 143275 / Each
Tourniquet (250 per pack beige) / 104586 / 250/ea / BD Affirm Tube (100/pk) / 477353 / Pack
Transfer Device Angel Wing / 203523 / Box / Group A Swab
Transfer Device / 147373 / 100/ea / Eswab Collection Kit / 467488
Alcohol Swabs / 457322 / 1000/ea / Stool Clean Vial / 398760
Bandaid / 314269 / 100/ea / Stool Culture / 139392
Cloraprep / 177779 / 20/ea / Ova and Parasite (O&P) Kit / 397550
Gauze / 314296 / 25/bag / CYTOLOGY/PATHOLOGY SUPPLIES
Lancet (200 per box) / 336043 / Each / Pap Vials (25 vials per box) / UH Path / Box
Syringe 10ml / 137555 / 100/ea / Thin Prep Kit: 25 Vials / 25 Brooms / UH Path / Box
Syringe 20ml / 137559 / 40/ea / Thin Prep Kit: 25 Vials / 25 Brush / UH Path / Box
REQUISITIONS / Cytolyt Solution: 30ml Tubes / UH Path / Box
Clinical Lab / UH Lab / Pack / Formalin (40 ml vials) / UH Path / Box
Microbiology/Molecular / UH Lab / Pack
Cytology / UH Lab / Pack / MISCELLANEOUS ITEMS
Pathology / UH Lab / Pack / Specimen Cups(Blue Lid w/straw) / 339394 / Each
ABN Forms / UH Lab / Pack / Glucola (Orange Flavor) 50g / 477354
Client Supply Order Form / UH Lab / Pack / Glucola (Orange Flavor) 75 g / 133611 / Each
Glucola (Orange Flavor) 100 g / 477355
SPECIMEN TRANSPORT / Fetal Fibronectin Kit / LCA / Kit
Specimen Bags (Small 6x9) / 196479 / pk / Stool Kit / LCA / Kit
Stat Labels / UH Lab / Roll / Fecal Fat Collection Can / LCA / Can
Quantiferon Collection Kit / LCA / Kit
Urine Straws (1000) / 339393 / Box

Allow 5 working days for delivery. Request non Lawson items from Outreach Manager via fax 584-3905.

ORCLI_Sept12